A high-speed rotational atherectomy device for opening a stenosis in an artery having a given diameter, comprising: a guide wire a flexible elongated, rotatable drive shaft advanceable over the guide wire, the drive shaft having a proximal end and a distal end and a piloting element fixedly attached to the drive shaft. When the piloting element is advanced to a stenosis, the piloting element creates a piloting hole when the drive shaft is rotated.
